Cancer cervix is the second most important cancer in India over the last two decades.
Why must we know these figures? Because Cancer Cervix is rampant and a huge killer.
It causes 23.5 % of all cancers in women in India.
Globally age-adjusted incidence rates are 15.3/100000. In India, this is 27/100000.
The incidence has reduced in urban areas but in rural areas, with limited-resource settings in medical treatment, it is still very high.
Every year about 134420 cases are added in India and about 75000 deaths occur due to the same. (2008)
By 2025 the projected increase in numbers is up to 116171.
-Why vaccinate?
We do not know the reasons behind many cancers, however, this is not true about the Cancer cervix. It is caused by a very common virus called HPV or Human Papillomavirus which is sexually transmitted. If we target girls for vaccination before they start with sexual activity , it will protect against this extremely ominous disease.
Which vaccines are available?
There are 2 vaccines available in India.
One is called Gardasil
The other is called CervarixGardasil protects against HPV 6,11,16,18,31,33,45,52,53
Gardasil also protects against genital warts, cancer of the anus, vagina and vulva, and is also licensed for males( though not in India)
Cervarix protects against the two high-risk HPV viruses 16,18
HPV 16 and 18 are the high-risk viruses and cause 66% of cases of cervical cancer. The rest cause around 15 % cases.
Low-risk HPV viruses cause anal and genital warts.
Who is to be vaccinated?
HPV vaccination is indicated for girls between 9-26 years of age. Some clinicians also propose vaccination till 45 years of age.
How many doses are to be given?
For girls between 9-14 years, 2 doses are indicated, one at 0 months, the other 6-12 months later.
For girls who receive the first dose on their 15 th birthday or later, 3 doses are required, at 0 months,2 months and 6 months.
For immunocompromised patients even less than 15 years,3 doses are needed.
Mode of administration?
Intramuscular
What are the side effects of HPV vaccines?
The side effects are minor and cause fever, dizziness, nausea, mild pain in the upper arm at the site of injection.
Are they indicated in pregnancy?
No. However if inadvertently given to a pregnant lady, this is not an indication to terminate the pregnancy.
Some pertinent questions:
If someone in the age group of 9-14 years gets 2 doses but less than 5 months apart do we need to give a third dose?
YES
If someone is more than 15 years of age but vaccination was started at 11 years of age, are 2 doses needed or 3?
1 DOSE as the first dose of vaccination was initiated before the 15 th birthday.
If the vaccination schedule was interrupted do all doses need to be repeated?
NO
Do we still need to screen for cervical cancer?
YES
